1. Field of the Invention
The urethra is a tube about 4 cm long which is normally closely attached by ligamentous and musculofacial tissue supports to the pelvic bone. Its point or union with the bladder, called the urethrovesical (u-v) junction or bladder neck, is located behind the pubic bone; the structure is such that an increase in intraabdominal pressure (as from coughing) will not permit escape of urine through the urethra.
Weakening and stretching of the attachment of the urethra to the pubic bone, which sometimes result from childbirth, may allow the u-v junction to prolapse and cause stress urinary incontinence, the involuntary escape of urine during coughing, sneezing, or other actions producing such stress. This condition is corrected by surgical restoration of the u-v junction to its orthotopic position.
Various operations have been devised to restore the elevation of the bladder neck junction. Their purposes are to restore the junction to its elevated position.
A problem in the Pereyra operation is the need for precise control of the ligature carrier needle, which is inserted through the tough abdominal fascia, advanced down between the posterior pubis and the anterior bladder wall and projected out through the vagina.
1. Discussion of the Prior Art
In a prior operation of this type invented by the present inventor, a ligature carrier of different design was employed with a retractable needle sliding inside an angulated hollow needle. With the first needle extended behind the pubic bone, the presence of two needles therein added to the difficulties of control. The small handles provided did not permit the precise control desirable. This prior device is briefly described and illustrated later herein.